Rates of potentially unsafe medication prescribing were found to be significantly higher among veterans with dementia using more than one health system.
Using more than one health system can have a negative effect on patient safety, according to a study published Monday in the Annals of Internal Medicine.
Specifically, the study found that rates of potentially unsafe medication prescribing were significantly higher among veterans using more than one health provider.
Those rates were significantly higher among veterans with dementia using more than one health system compared to those using only the Department of Veterans Affairs providers.
According to the study, the average dementia patient has four co-morbid conditions and receives care from five different providers annually. Medication management is particularly challenging because the average patient takes five different drugs, and 16% of patients take nine or more.
Provision of highly coordinated care is fundamental to prescribing safety in dementia patients, the study suggests.
The research originated in the Center for Health Equity Research and Promotion at the Veterans Affairs' Pittsburgh Healthcare System, and the Center for Health Services Research in Primary Care at the Durham Veterans Affairs Medical Center, in Durham, NC.
"Recent federal policy changes to expand access to care may have unintended consequences that thwart the VA's efforts to enhance care coordination," the study states.
In 2006, the introduction of the Medicare Part D prescription drug program expanded veterans' access to medications through non-VA health care systems, in which eligibility for Part D is independent of VA benefits.
Subsequent legislation further expanded veterans' ability to seek care outside the VA system.
Although this study claims to be the first to focus on prescribing quality and safety with patients seeking care in both VA and non-VA systems, previous studies show such use to lead to duplication and overuse of other health services, and worse health outcomes.
"Successful co-management requires that health information exchange between systems—currently the responsibility of veterans and caregivers—needs to improve," the report states. Pilot programs, such as the VA Virtual Lifetime Electronic Record, show "great potential" to facilitate health information sharing between VA and non-VA providers.
Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.